Palatoplasty: evolution and controversies.

Treatment of cleft palate has evolved over a long period of time. Various techniques of cleft palate repair that are practiced today are the results of principles learned through many years of modifications. The challenge in the art of modern palatoplasty is no longer successful closure of the cleft palate but an optimal speech outcome without compromising maxillofacial growth. Throughout these periods of evolution in the treatment of cleft palate, the effectiveness of various treatment protocols has been challenged by controversies concerning speech and maxillofacial growth. This article reviews the history of cleft palate surgery from its humble beginnings to modern-day palatoplasty, and describes various palatoplasty techniques and commonly used modifications. Current controversial issues on the timing of cleft palate repair, and the effects on speech and maxillofacial growth are also discussed.